General Frequently Asked Questions
IS REID ELAM AND HIS FAMILY RELATED TO JASON ELAM, THE KICKER FOR THE NFL’S DENVER BRONCOS?
Yes. Reid’s grandfather is originally from Georgia where Jason’s family is from. Reid and Jason are cousins.
DO I HAVE TO FILL OUT INSURANCE PAPERS?
One of the advantages of choosing ESO for your therapy is that we eliminate the amount of paperwork that you have to do so we will file insurance claims for you.
WILL MY INSURANCE COVER MY THERAPY?
Each and every insurance plan varies in the amounts and type of medical coverage offered. It is between you and your insurance company to understand your benefits. Prior to receiving rehabilitation services we will verify your benefits however, it is to your advantage to understand your plan and be aware of any limitations. If your insurance company does not cover our services in full, you are responsible for the remaining amount(s) due. If you have any questions, we’d be happy to assist you.
WHAT IF I HAVE MEDICARE?
Effective January 1, 2000 – Medicare Part B will pay 80% of eligible fees after your deductible. Medicare has a $100 annual deductible (this may have been met with another doctor seen prior to us). You are responsible for your $100 deductible and 20% of the eligible fee. Effective January 1, 2009 – Medicare will not pay for physical therapy and speech language pathology services over $1810.00 in 2009. According to the Medicare legislations, the $1810.00 cap is a per beneficiary annual cap. It does not apply per diagnosis nor per provider. It is vital for you to inform our office of any prior physical therapy visits you may have had in the past or are currently attending. Please note, that Medicare will pay 80% of the $1810.00 cap or $1448.00 (after the $100.00 deductible is met).
CROSS-OVER: If you have any insurance in addition to Medicare, your claim may automatically “cross-over” to your secondary insurance which may cover all or part of the 20% co-payment. This service is available if you have notified Medicare of your secondary insurance information.
WHAT IF I HAVE HMSA 65C OR 65C+?
HMSA 65C and 65C+ plans generally pay 100% of the eligible fee. Because these plans follow Medicare guidelines, the Medicare cap instituted January 1, 2009 may apply.
WHAT IF I HAVE HMSA?
HMSA allows a limited number of physical therapy visits based on your diagnosis. This is per injury without the need for prior authorization. If your condition requires additional visits, our staff will attempt to obtain the authorization for continued treatments. However, HMSA has claimed that they will not extend any treatments past the limited amount effective January 1, 2004. It is vital for you to inform our office of any prior physical therapy visits you may have had in the past or are currently attending. This information is necessary so we can follow up on pre-authorizations needed for you to continue therapy. You are responsible for your annual deductible and amounts not covered by HMSA. Annual deductibles and percentages paid by HMSA after your deductible vary from plan to plan. Although you may have met your deductible while seeing another provider, many HMSA plans have a separate deductible for physical therapy (major medical benefit).
WHAT IF I AM ON WORKERS’ COMPENSATION OR NO FAULT?
Generally, approved coverage for treatment will be at 100% of the eligible fee. In some cases where litigation is involved, there may be documents that need to be forwarded to ESO by your legal counsel as reimbursement for treatment service that could be deferred. Please check with ESO and your adjustor regarding the latter.
WHAT IF I AM NOT ABLE TO MAKE MY APPOINTMENT?
Because our therapists dedicate time just for you, please notify your therapist or our office staff at least 24 hours in advance if you are unable to attend a scheduled therapy session. If unexpected circumstances arise, please contact us as soon as possible to allow our therapists time to adjust their schedule. Your cooperation in this matter is sincerely appreciated. A $15.00 charge will be assessed if 24 hours advance notice of cancellation is not given. Excessive cancellation and no-show appointments may require a return to your physician for an updated prescription.
HOW LONG WILL I BE COMING TO PHYSICAL THERAPY? HOW OFTEN SHOULD I COME?
Your referring physician most likely prescribed a frequency and duration for your therapy. It is best to adhere to his or her recommendations, but we understand if your busy schedule doesn’t allow it. Try to follow the schedule as closely as prescribed. If you miss an appointment early during the week, we highly encourage you to make up that visit some time during the week…even if your appointments follow on back-to-back days.
HOW LONG DOES EACH SESSION LAST?
We ask patients to set aside one hour for each therapy session. Two hours may be required if you are being treated for two separate diagnoses. For a more specific time guideline, consult your therapist.
WHAT ARE THE THERAPISTS’ WORKING HOURS?
Our Kapolei and Pearl City clinics are open Monday through Friday from 8:00 am to 6:00 pm and Saturdays from 8:00 am to 1:00 pm. Mobile therapists at ESO set their own schedules. Please discuss scheduling concerns with your therapist or the clinic receptionist.
WHAT IF MY DOCTOR OR INSURANCE DECLINE CONTINUING THERAPY, BUT I STILL FEEL LIKE I NEED MORE?
ESO programs that are post prescription include reconditioning, which is a continuum of therapeutic exercise to provide improved overall fitness and maintenance. Should you receive a prescription from your physician for reconditioning your insurance coverage should remain in effect. “Got Your Back” is another program that enables patients who have a pause in their rehabilitation due to a recertification lag (insurances such as HMSA), an end to their therapy due to limited visitations because of insurance regulations or a cap (i.e. Medicare) and need to continue their treatments. It is a discounted out-of-pocket program that allows patients to continue therapy at an affordable cost. The discounts are accorded to all patients who wish to continue therapy because their insurance will no longer cover services provided by ESO, including pool therapy. To take advantage of this offer, our clinic receptionists will be able to provide more information. As for continuing therapeutic exercise and maintenance after being discharged from therapy, the patient has the option to continue through ESO’s Beyond RxSM program, which is a program of privilege designed for former Elam Sports O`ahu™ patients who successfully completed Phase 4 / Level IV, independent exercisers and those not appropriate for skilled Physical Therapy. This program is available at a nominal cost. This cost is a monthly fee with no contractual obligations paid by the patient. Please refer to the Beyond RxSM section of your Rehab Playbook or call the ESO office at 674-9595 for more information.
HOW LONG DOES IT TAKE TO HEAL FROM SURGERY?
Of course, recovery is dependent on the extent of injury and the type of surgery itself but…we generally adhere to a “3-6-12 Rule” regarding healing phases for surgery. Up to 3 months, you will experience the effects of inflammation (and re-inflammation through rehabilitation) which is the 1st stage of healing – and quite normal. At 6 months you will have forgotten about your surgery ordeal and be quite functional, but complete healing does not occur until 12 months when all cellular remodeling is pau!
WHY AM I STILL IN PAIN?
Inflammation is the primary cause of pain. Dependent on the site and extent of injury, this could be a “roller coaster” ride initially but will generally subside with time.
SHOULD I TAKE MEDICATION BEFORE I COME TO PHYSICAL THERAPY?
Opt for pain medications before therapy if you feel that the medicine will help you get through your session.
DID YOU GET MY X-RAYS / MRI / CT SCAN FROM MY DOCTOR?
No. If on file, we may request a copy of the report from you doctor, which you as a patient may do at any time.
WHAT IS MANUAL THERAPY?
“Hands-on” procedures performed by the Physical Therapist, and includes joint mobilization, soft tissue manipulation (i.e. scar tissue mobilization), manual traction, passive stretching, manually-resisted exercise, segment posturing, and more.
WHAT SHOULD I DO TO MY HOME TO MAKE IT SAFER?
Ask your Physical Therapist. They can make suggestions about additions, deletions or modifications to your home environment.
WHAT IS THE DIFFERENCE BETWEEN PHYSICAL THERAPY AND CHIROPRACTORS?
Basically, chiropractors (DC’s) link health with the spine and are trained / educated in the art of spinal manipulation. Physical Therapists (PT’s) link health to function and are trained / educated in methodologies to restore function when impairment or disability limits it.